Even as cases in Texas have slowed, measles is spreading in other U.S. states, concerning health officials.

While Texas leads states with 729 confirmed cases, New Mexico has jumped to 79 and Kansas to 58, according to the latest tracking by the Centers for Disease Control and Prevention.

Overall, 1,050 measles cases have been reported in 31 states, meaning this year is likely to have the most measles cases since the virus was declared eliminated in the U.S. in 2000.

Tammy Camp, MD, is a pediatrician at Texas Tech University Health Sciences Center in Lubbock, Texas, which is near ground zero of the measles outbreak in January in west Texas. To underscore how rare measles outbreaks had become in the U.S., Camp, speaking at a May 27 webinar called “Measles 2025: The State of the Outbreak,” had never seen a measles patient in 30 years of her pediatric practice. Now she has seen many.

Camp acknowledged that while people have a choice to sit or to have their children sit for an MMR vaccine, many who are immunocompromised cannot be vaccinated and rely on “community immunity” as their safeguard. These people and infants who cannot be vaccinated are placed at risk when a community is undervaccinated.

“That is where community immunity becomes so important,” Camp said at the online event, cohosted by APHA, the National Academy of Medicine and other organizations. “It is important to keep that vaccination rate high, so people who cannot make the choice (for vaccination) can be immune.”

When over 95% of people have uptake of the MMR vaccine, community immunity protects most people, said Bonnie Maldonado, MD, professor of pediatrics, infectious diseases and epidemiology at Stanford Medicine Children's Health. But in the U.S., MMR vaccinations have steadily dropped in recent years.

In the U.S. outbreaks this year, 12% of infected people have been hospitalized and three have died since the first outbreak in west Texas, CDC says.

“Cases are significantly undercounted as many have never sought care,” said Camp, an associate professor of pediatrics at the Health Sciences Center.

Measles is highly contagious, and though most cases include skin spots, the infection can also be asymptomatic or manifest only as flu symptoms, increasing risk of spread. 

Someone with measles can infect on average 12 to 18 other people, said Heidi Larson, PhD, director of the Vaccine Confidence Project. And misinformation about the infection can create an environment where measles spreads fast through communities.

In times of crisis, people tend to turn to family and friends, rather than scientists, for information, she said. The challenge for public health officials is to be viewed with that same level of trust.

Larson referenced a 2021 report from the World Economic Forum that found that words and phrases used by health officials matter. For example, during the COVID-19 pandemic, messaging that talked about “protection” from the virus for family and friends rather for an abstract “moral obligation” was more successful.

“Messages that are simple, focused on gratitude and coming from health professionals, social influencers and ‘people like me’ elicit more positive responses than messages from celebrities/politicians,” the report said.

“Hold your breath and listen to the reasons” people give for not wanting to be vaccinated, Larson said. “It might sound simplistic, but it is worth understanding. It might be an access issue (for them), or they might give a reason to help you understand. At least give it a try.”

Photo by FatCamera, courtesy iStockphoto